The qualitative study of intentional self-harm in Thailand: Focusing on predisposing child - rearing environments and self-harm cessation

Introduction Intentional self-harm in adolescents and young people included both suicidal behaviors and nonsuicidal self-injury (NSSI) is a serious issue in mental health systems. However, the majority of studies on self-harm in adolescents and young people focused on quantitative methodology which might has limitations to explain this complex phenomenon of intentional self-harm. Objectives This study aimed to describe the subjective experiences of adolescents and young people who presented with intentional self-harm in order to provide better understanding of this behavioral phenomenon. Methods This is an exploratory qualitative study used phenomenological processes and thematic analysis. Results Twenty subjects aged 13-29 years were included in this study. The results revealed 6 themes regarding predisposing child - rearing environments and 9 themes regarding factors related to cessation of intentional self-harm. - 6 themes regarding predisposing child - rearing environments Lack of emotional responsiveness/emotional neglect Negativity, criticism and harsh punishment High academic expectations Comparison with siblings Superficial responsiveness Enmeshment and over involvement - 9 themes regarding factors related to cessation of intentional self-harm Negative perception to self-harm and desire to stop Increase of adaptive coping Finding life purposes Improvement of psychiatric symptoms Supportive relationships and verbalization Treatments / interventions Unwanted consequences of self–harm Situations related to positive feelings Behavioral control Moreover, this study demonstrated the important functions of self-harm as an intrapersonal strategy for emotional regulation. Conclusions This study underscored the importance to view self-harm as a complex phenomenon and it is essential to understand the developmental pathways as well as the pathways to cessation of these complex behaviors. Moreover, various internal and external factors related to cessation of intentional self-harm were demonstrated and verbalization in safe and supportive atmosphere tended to be an important process to promote the cessation or decrease of intentional self-harm. Disclosure of Interest None Declared

Introduction: Repeated self-harm represents the single strongest risk factor for suicide.Worldwide, suicide is the second leading cause of death in young people aged 15-29 year, and the leading cause of death in many Asian countries.Objectives: This qualitative study was nested in a multi-center effectiveness trial of a Youth Culturally-adapted Manual Assisted Problem-solving intervention (Y-CMAP) for prevention of self-harm in Pakistan and aimed to explore young people's perspective on the intervention.Methods: One-to-one in-depth qualitative interviews were conducted with 20 participants from 5 cities across Pakistan, using a semi-structured topic guide to explore their views about self-harm, Y-CMAP intervention content, perceived effectiveness and challenges.Interviews were conducted in Urdu language, digitally recorded, transcribed verbatim and translated into English.Thematic analysis was conducted by the trained qualitative researchers.Results: Interpersonal conflicts including relationship difficulties, financial problems, and lack of social support were highlighted as precipitating factors of self-harm.Participants reported that Y-CMAP intervention is structured and easy to understand.They acknowledged the role of distraction techniques, cost-benefit analysis, discussion on thinking pattern, problem-solving and anger management in improving their mental health and wellbeing and reduce self-harm.Participants also shared their initial fears regarding the intervention, such as fear of disclosure of information to media.School and job timings were described as potential challenges for participation in the intervention.Conclusions: Exploring the perspectives of young people about culturally-appropriate intervention is imperative in their journey towards preventing suicide, which is a preventable cause of premature death.Findings are particularly relevant for Pakistan, one of the youngest nations in the world with limited resources for suicide prevention.

EPV1078
The qualitative study of intentional self-harm in Thailand: Focusing on predisposing child -rearing environments and self-harm cessation

N. Limsuwan
Introduction: Intentional self-harm in adolescents and young people included both suicidal behaviors and nonsuicidal self-injury (NSSI) is a serious issue in mental health systems.However, the majority of studies on self-harm in adolescents and young people focused on quantitative methodology which might has limitations to explain this complex phenomenon of intentional self-harm.
Objectives: This study aimed to describe the subjective experiences of adolescents and young people who presented with intentional self-harm in order to provide better understanding of this behavioral phenomenon.Methods: This is an exploratory qualitative study used phenomenological processes and thematic analysis.Results: Twenty subjects aged 13-29 years were included in this study.The results revealed 6 themes regarding predisposing childrearing environments and 9 themes regarding factors related to cessation of intentional self-harm.
-6 themes regarding predisposing child -rearing environments 1. Lack of emotional responsiveness/emotional neglect 2. Negativity, criticism and harsh punishment 3. High academic expectations 4. Comparison with siblings 5. Superficial responsiveness 6. Enmeshment and over involvement -9 themes regarding factors related to cessation of intentional self-harm 1. Negative perception to self-harm and desire to stop 2. Increase of adaptive coping 3. Finding life purposes 4. Improvement of psychiatric symptoms 5. Supportive relationships and verbalization 6. Treatments / interventions 7. Unwanted consequences of self-harm 8. Situations related to positive feelings 9. Behavioral control Moreover, this study demonstrated the important functions of selfharm as an intrapersonal strategy for emotional regulation.Conclusions: This study underscored the importance to view selfharm as a complex phenomenon and it is essential to understand the developmental pathways as well as the pathways to cessation of these complex behaviors.Moreover, various internal and external factors related to cessation of intentional self-harm were demonstrated and verbalization in safe and supportive atmosphere tended to be an important process to promote the cessation or decrease of intentional self-harm.

EPV1079
More folate intake, less suicide attempts: is there a link ?N. Kouki*, A. maamri, M. A. Zaafrane, D. Bougacha, A. hajri and H. Zalila Introduction: Suicide is a major health problem, mostly related to mental health disorders.However psychological autopsies have revealed the presence of unexpected suicide factors such as dietary patterns particularly folate intake.Which is a naturally occurring form of B9 essential for neurogenesis, nucleotide synthesis and methylation of homocysteine.Objectives: The aim of our study is to identify the link between folate intake and suicidality.Methods: Our literature review was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar using the following combination ( suicide

[MeSH terms]) AND (folate [MeSH terms]) AND (prevention [MeSH terms]).
Results: Stress-induced neuronal dysfunctions interact with genetic and environmental factors, including diet, to precipitate mental health disorders in vulnerable or predisposed individuals especially mood disorders.In one hand, studies showed delayed onset of clinical improvement even treatment resistance in depressive patients treated with fluoxetine associated with low folate levels.In the other hand Folate depletion has been linked to serotoninergic metabolism disturb.Moreover, co-administration of methylfolate, a highly absorbable form of folic acid, has been found to augment the effects of SSRIs .A duration-response analysis (1-mg dosage) revealed a 5% decrease in suicidal events per month of additional treatment.
Conclusions: Accumulating data have shown that these nutrients can enhance neurocognitive function, and may have therapeutic benefits for depression and suicidal behaviors .But the pathological mechanism remains unclear that's why further studies are needed for a better comprehension and efficiency.The cultural meaning of suicide has been gaining attention in mainstream psychiatry literature, as an attempt to comprehend the dynamic relationship between culture and suicidality.Moreover, an understanding of the sociocultural and contextual factors in the aetiology of suicidal behaviour is important to develop culturally appropriate suicide prevention and intervention strategies.

Disclosure of
Objectives: Through the lenses of critical cultural suicidology, we aim to reflect on the relationship between suicide and sociocultural aspects, emphasizing the importance of context, cultural meanings, and the role of culture in suicide research and prevention strategies.Methods: We conducted a qualitative review on the topic using PubMed database.Search terms used: "suicidal behaviour"; "suicidal ideation"; "suicide"; "culture"; "cultural".Results: Studies revealed that culture might be significant to understand suicidal behaviour.Therefore, suicidologists have often referred to a cultural meaning of suicide.Several studies argue that qualitative studies that focus on the meanings of suicidal behaviour in different cultural contexts are more relevant for suicide prevention than much of the quantitative risk factor research that is currently being conducted.Scholars conceptualize culture as either a protective factor or a risk factor that shapes an individual's likelihood of engaging in a suicidal act.To locate culture's influence on suicidal behaviour is essential to begin with an examination of social interaction.The meanings of suicide from a group of people living in a cultural community might vary along subcultural groups and time.Thus, the meaning of suicide is dynamic rather than static.Such a view acknowledges culture as both occurring outside the person, as well as within the person and between persons.It provides a view of a dynamic relationship between the individual and his or her contextual circumstances in which the individual is not just a passive recipient of cultural influences but also an active meaning-making agent who interacts meaningfully with the environment.Conclusions: Although the medical view of suicidality is a dominant perspective in suicidology, understanding cultural dynamics in suicidality and the conceptualization of suicide as a culturally guided act, is crucial to better understand suicidal behaviours.Further studies are needed in order to understand this complex and dynamic relationship.

Disclosure of Interest: None Declared
Interest: None Declared EPV1080 Suicide and Culture: A Reflection on Suicidal Behaviour Through Cultural Context Introduction: